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Frequency of Radiographs

Do I need to take a full-mouth X-ray (FMX) within the same date allowance as the bitewings? If I take bitewings in April, can I take the FMX in December?

To assist with decisions regarding the frequency of taking radiographs, the American Dental Association developed guidelines to serve as an adjunct to the oral health professional’s  judgment of how to best use diagnostic imaging for each patient.1 They provide recommendations for prescribing dental radiographs after reviewing the patient’s health history, completing a clinical examination, and following the ALARA principle (“as low as reasonably achievable”).

Despite individualizing the need and frequency of radiographs, most patients are concerned whether recommended radiographs will be covered by their insurance provider. Most insurance plans have frequency limitations for each radiograph type. For example, bitewings may be covered once or twice a year, while an FMX series or a panoramic may be covered once every 2 to 5 years.

Although frequency limitations may exist, coverage of a specific type of radiograph can sometimes be rationalized by its clinical necessity. If an oral health professional can justify the need for a specific radiograph based on a patient’s dental issue, the insurance provider may approve coverage even if it is outside the defined frequency limitation.

If bitewing radiographs were taken in a particular month later in the calendar year and it was determined that an FMX series is warranted, insurance providers may cover the additional radiographs due to the different frequency allowances per radiograph type determined by each insurance policy. Specifically, an insurance policy may allow for bitewing radiographs to be taken one time per year and the FMX series taken once every 5 years so long as they were taken and billed on different days. In this situation, the frequency rules would apply.

If four bitewing and two periapical radiographs were exposed in a particular month and equal to the amount of an FMX series, a subsequent FMX series may not be covered. Every insurance company has its own allowable amounts and coverage schedule, of which office managers and patients should have knowledge.

In summary, there is no one-size-fits-all approach regarding the frequency and coverage of dental radiographs. While radiographs are important in diagnosing and preventing oral health conditions, covered services and amounts vary by insurance plans. When determining the necessity for radiographs, dental professionals should expose radiographs according to the needs of the patient, not what is dictated by insurance providers.

Reference

  1. American Dental Association. Dental Radiographic Examinations: Recommendations for Patient Selection and Limiting Radiation Exposure. Available at: ada.o/​g/​resources/​practice/​practice-management/​radiographic-imaging. Accessed September 21, 2024.

From Dimensions of Dental Hygiene. October/November 2024; 22(6):54.

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